Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
e-Letters: Comments and Responses

Comment on Inzucchi et al. Pioglitazone Prevents Diabetes in Patients With Insulin Resistance and Cerebrovascular Disease. Diabetes Care 2016;39:1684–1692

  1. Niki Katsiki1 and
  2. Dimitri P. Mikhailidis2⇑
  1. 1Second Propedeutic Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
  2. 2Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London, London, U.K.
  1. Corresponding author: Dimitri P. Mikhailidis, mikhailidis{at}aol.com
Diabetes Care 2017 Apr; 40(4): e46-e46. https://doi.org/10.2337/dc16-2301
PreviousNext
  • Article
  • Info & Metrics
  • PDF
Loading

We read with interest the results of the Insulin Resistance Intervention after Stroke (IRIS) trial prespecified secondary analysis for type 2 diabetes mellitus (T2DM) prevention, in which Inzucchi et al. (1) reported that pioglitazone almost halved the risk of T2DM development in insulin-resistant patients with cerebrovascular disease. This effect was driven by a larger impact in participants who at baseline had HbA1c >5.7% (39 mmol/mol), impaired fasting plasma glucose (>100 mg/dL [5.6 mmol/L]), higher HOMA of insulin resistance (≥4.6), and metabolic syndrome (1).

One of the potentially beneficial effects of thiazolidinediones is that they may decrease serum uric acid concentrations, which may in turn predict vascular risk (2). Therefore, it would be useful to evaluate this effect in the IRIS trial.

Nonalcoholic fatty liver disease, the hepatic manifestation of metabolic syndrome, has been associated with increased risk for T2DM and cardiovascular morbidity and mortality (3). In the earlier IRIS publication, significantly fewer patients on pioglitazone than those on placebo had alanine aminotransferase activity greater than the upper limit of the normal range (4). In this context, did the Inzucchi et al. (1) investigate whether pioglitazone affected development of nonalcoholic fatty liver disease?

Postprandial lipemia (PPL) has been related to increased cardiovascular risk (5). Pioglitazone was shown to reduce fasting triglyceride (TG) levels in the IRIS trial (4). As elevated fasting TGs increase the incidence of PPL (5), the TG-reducing effect of pioglitazone may decrease the prevalence of PPL.

Overall, multiple beneficial metabolic effects may account for the positive clinical outcomes observed with pioglitazone in the IRIS trial.

Article Information

Duality of Interest. N.K. has given talks, attended conferences, and participated in trials sponsored by Amgen, Angelini, AstraZeneca, Boehringer Ingelheim, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, and WinMedica. D.P.M. has given talks and attended conferences sponsored by Merck Sharp & Dohme, AstraZeneca, and Libytec Pharmaceutical. No other potential conflicts of interest relevant to this article were reported.

  • © 2017 by the American Diabetes Association.
http://www.diabetesjournals.org/content/license

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.

References

  1. ↵
    1. Inzucchi SE,
    2. Viscoli CM,
    3. Young LH, et al.; IRIS Trial Investigators
    . Pioglitazone prevents diabetes in patients with insulin resistance and cerebrovascular disease. Diabetes Care 2016;39:1684–1692
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Rizos CV,
    2. Liberopoulos EN,
    3. Mikhailidis DP,
    4. Elisaf MS
    . Pleiotropic effects of thiazolidinediones. Expert Opin Pharmacother 2008;9:1087–1108
    OpenUrlCrossRefPubMedWeb of Science
  3. ↵
    1. Katsiki N,
    2. Mikhailidis DP,
    3. Mantzoros CS
    . Non-alcoholic fatty liver disease and dyslipidemia: an update. Metabolism 2016;65:1109–1123
    OpenUrl
  4. ↵
    1. Kernan WN,
    2. Viscoli CM,
    3. Furie KL, et al.; IRIS Trial Investigators
    . Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med 2016;374:1321–1331
    OpenUrlCrossRefPubMed
  5. ↵
    1. Kolovou GD,
    2. Mikhailidis DP,
    3. Kovar J, et al
    . Assessment and clinical relevance of non-fasting and postprandial triglycerides: an expert panel statement. Curr Vasc Pharmacol 2011;9:258–270
    OpenUrlCrossRefPubMed
PreviousNext
Back to top
Diabetes Care: 40 (4)

In this Issue

April 2017, 40(4)
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by Author
  • Masthead (PDF)
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Comment on Inzucchi et al. Pioglitazone Prevents Diabetes in Patients With Insulin Resistance and Cerebrovascular Disease. Diabetes Care 2016;39:1684–1692
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Comment on Inzucchi et al. Pioglitazone Prevents Diabetes in Patients With Insulin Resistance and Cerebrovascular Disease. Diabetes Care 2016;39:1684–1692
Niki Katsiki, Dimitri P. Mikhailidis
Diabetes Care Apr 2017, 40 (4) e46; DOI: 10.2337/dc16-2301

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Comment on Inzucchi et al. Pioglitazone Prevents Diabetes in Patients With Insulin Resistance and Cerebrovascular Disease. Diabetes Care 2016;39:1684–1692
Niki Katsiki, Dimitri P. Mikhailidis
Diabetes Care Apr 2017, 40 (4) e46; DOI: 10.2337/dc16-2301
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Article Information
    • References
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Response to Comment on Herring et al. Metabolic Effects of an SGLT2 Inhibitor (Dapagliflozin) During a Period of Acute Insulin Withdrawal and Development of Ketoacidosis in People With Type 1 Diabetes. Diabetes Care 2020;43:2128–2136
  • Comment on Herring et al. Metabolic Effects of an SGLT2 Inhibitor (Dapagliflozin) During a Period of Acute Insulin Withdrawal and Development of Ketoacidosis in People With Type 1 Diabetes. Diabetes Care 2020;43:2128–2136
  • Response to Comment on Gan et al. Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care 2020;43:1948–1957
Show more e-Letters: Comments and Responses

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.